Standard DoseOne 300 mg tablet once daily (or one 150 mg tablet twice daily), without regard to food. Dosing needs to be adjusted for adults and children who have decreased kidney function (creatinine clearance less than 50 mL/min). This medication, however, is often used in reduced renal function below 50 mL/min due to relatively minimal risk of lamivudine accumulation and side effects. See package insert for guidance on dosing in the setting of kidney impairment. Must be taken in combination with another antiretroviral(s).
According to the package insert, it is indicated for adults and children at least 3 months of age. Based on pediatric DHHS guidelines, it can be used as part of a presumptive HIV regimen in infants of at least 32 weeks’ gestation at birth for higher risk perinatal HIV exposure. Epivir for children is dosed based on body weight. See the package insert or DHHS guidelines for weight-based dosing.
Take missed dose as soon as possible, unless it is closer to the time of your next dose. Do not double up on your next dose. The 150 mg tablets are scored and may be split. Based on drug properties, tablets may be crushed and added to a small amount of semi-solid food or liquid for immediate consumption. Epivir is also available as an oral solution (10 mg/mL) (strawberry-banana flavor) for children and adults who are not able to swallow the tablets. Epivir can be substituted for Emtriva.
- See package insert for more complete information on potential side effects and interactions.
AWPEpivir not available on formulary used
Potential Side Effects and Toxicity
Epivir is very well tolerated. The most common side effects (which were rarely reported) were headache, diarrhea, nausea, malaise (general ill feeling), fatigue, nasal symptoms, and cough. Prior to initiation, people should be tested for hepatitis B virus (HBV) infection. Severe exacerbations of hepatitis B have been reported in people co-infected with HBV who have discontinued Epivir (because lamivudine also treats HBV). Monitor liver enzymes closely in people co-infected with hepatitis B and, if appropriate, initiation of anti-hepatitis B therapy may be warranted upon Epivir discontinuation. Call your health care provider right away if you develop any of the following signs or symptoms of hepatitis: yellowing of the skin or whites of the eyes; dark or tea-colored urine; pale-colored bowel movements; nausea or vomiting; loss of appetite; or pain, aching, or tenderness on the right side below the ribs.
Potential Drug Interactions
Do not take with Cimduo or Temixys, Descovy, Emtriva, Epivir-HBV, Hepsera, or Truvada, which are used for the treatment of hepatitis B. No other significant drug interactions. Epivir may be used with hepatitis C drugs Epclusa, Harvoni, or Zepatier, depending on the other components in the HIV regimen. Avoid use of sorbitol-containing medicines with lamivudine; there are many, such as acetaminophen liquid (Tylenol liquid and others). Tell your provider or pharmacist about all medications, herbals, and supplements you are taking or thinking of taking, prescribed or not.
This drug is used almost exclusively as part of combination tablets. Epivir (lamivudine) is similar to Emtriva (emtricitabine): both treat HIV and HBV and have the same resistance profile, meaning that if your virus is resistant to one drug, it will be resistant to the other. If your HIV develops resistance to lamivudine, it doesn’t mean that your HBV is also resistant to it. Sometimes, drug resistance that the virus develops against lamivudine makes the virus reproduce at a slower rate. This drug resistance can also improve the antiviral activity of Retrovir (zidovudine, or AZT—very rarely taken today) and Viread or Vemlidy (tenofovir), and for that reason, some providers continue Epivir treatment in combination with other antiretrovirals after resistance develops. Lamivudine is also available in several combination products: Cimduo and Temixys (with tenofovir DF), Combivir (with zidovudine), Epzicom (with abacavir), Trizivir (with zidovudine and abacavir), Symfi and Symfi Lo (with tenofovir DF and efavirenz), Delstrigo (with tenofovir DF and doravirine), Dovato (with dolutegravir), and Triumeq (with dolutegravir and abacavir). Epzicom is recommended as a preferred initial regimen in pregnancy. Epivir as part of the combination tablet Combivir is recommended as an alternative NRTI combination component of an HIV treatment regimen during pregnancy. Epivir is available as generic lamivudine, which should be as effective and well tolerated as the brand name drug Epivir. Some insurers may require people to take regimens containing generics rather than brand name drugs, including simpler co-formulated products. The availability of generics might also limit choices of therapy. For example, newer brand name drugs and co-formulations, such as Biktarvy, might be restricted to people who can’t physically tolerate generic regimens. Pregnant individuals can voluntarily enroll in the Antiretroviral Pregnancy Registry through their provider; go to apregistry.com.
Dr. Melanie Thompson:
Lamivudine or 3TC is the oldest HIV med still in widespread use, generally paired with abacavir or TDF. It is viewed by guidelines panels as interchangeable with FTC for treatment, but not intended for prevention. It is included in Triumeq, Delstrigo, Dovato, Symfi, Symfi Lo, Cimduo, and Temixys, as well as the dual nuke combos Epzicom and Combivir. Resistance occurs rapidly when virus breaks through, but its signature resistance mutation, M184V, has a beneficial effect on some other drugs like AZT and tenofovir. It also has some activity against hepatitis B.
Activist Michael Broder:
Approved in 1995, Epivir (lamivudine) was one of the first five NRTIs, and the only one still in wide use. Epivir is among the safest, most tolerable, and most convenient HIV drugs available, with no significant side effects. A very potent drug, it is half of a complete HIV regimen when combined with the INSTI dolutegravir, co-formulated as the single-tablet regimen (STR) Dovato. Epivir is also part of a complete HIV regimen when combined with Tivicay (dolutegravir) and tenofovir alafenamide (TAF) or tenofovir disoproxil fumarate (TDF). The generic form, lamivudine, is included in the branded generic fixed-dose combinations (FDCs) Cimduo and Temixys (alongside TDF). Epivir is a close chemical relative of Emtriva (emtricitabine); but for what it’s worth, Epivir came first, and Emtriva was brought to market specifically to compete with Epivir—which it has done quite successfully for some 20 years.